T Nation

Issues with TRT in Australia

Im 25 years old and i started using testogel about a year and bit ago on and off.
I weigh 82kg and have a height of 192cm.
I have gynecomastia and hold most of my fat on my face, chest, stomach and bum and
quite skinny everywhere else this has been the case since puberty.
Prior to use of testogel i produced almost no facial hair and now i produce a fair amount more but not enough to grow a beard.

I feel tired all the time and have constant trouble sleeping, It is very difficult to build muscle, i am having trouble remembering things and focusing on uni.
I do not get morning or nocturnal erections and prior to the testogel i was barely able to maintain a normal erection.

I do not understand what is wrong with me and i feel like doctors/endocrinologist are just brushing me off.

I currently take 25mg of of transdermal testostrone with the brand name TESTOGEL.
From my understanding this is a quite low dose.
1 vitamin-D capsule

My blood tests prior/@25mg/@50mg * range
Testostrone 8.9 // 22 // >52 * (8.3-29)nmol/L
(the blood test only records up to 52nmol/L)
E2 81 // 160 // 155 * (<150)pmol/L
FSH 5 // 1 *(<7) IU/L
LH 4.6 // 0.5 *(<7) IU/L
PROG ? // 4 *(0.9-3.9)nmol/L

After being on 50mg for a couple of weeks i had a test
Total Testosterone (Centaur) 27nmol/L (8.3-29)
Sex Hormone Binding Globulin 19 nmol/L (11-71)
DHEAS 8.1 umol/L (3.0-10)
Androstenedione 7.1 nmol/L (2.1-11)
Calculated Free Testosterone 720.6 pmol/L (255.0-725.0)
The endocrinologist was happy with these numbers so i was meant to stay on this dose but every day i started to feel a little bit worse and a few months past and i felt like i had lost the ability to think accompanied by constant migraines and loss of strength. Despite
a constant gyming routine of every second day i was noticeably able to lift less and less every session. After a few months i got the blood test just to check up where it was at and discovered my testosterone was at a ridiculously high level.

Thyroid tests before starting testosterone
TSH 4.78 // 3.70 *(0.34-3.40)mIU/L
fT4 ? // 15.1 *(10.7-17.0)pmol/L
fT3 ? // 5.0 *(3.4-5.4)pmol/L
Thyroglobin Ab ? // 3.6 *(>5)kU/L
TPO Ab ? // <0.5 *(<6)kU/L
Thyroid tests after starting testosterone but then stopping (different lab / doctor)
TSH 2.0 // 2.4 // 1.6 *(0.5-4.0)mIU/L

This blood work was just before i discovered i had testostrone on the low side
Na 141 mmol/L (135-145)
K 4.3 mmol/L (3.6-5.4)
Cl 102 mmol/L (95-110)
HCO3 28 mmol/L (22-32)
An Gap 15 (10-20)
Urea 4.2 mmol/L (2.5-7.5)
Creat 70 umol/L (60-110)
eGFR >90
Bili 16 umol/L (<20)
AST 217 U/L (<35)
ALT 89 U/L (<40)
GGT 15 U/L (<40)
Alk Phos 57 U/L (35-110)
Protein 74 g/L (60-82)
Albumin 48 g/L (38-50)
Glob 26 g/L (20-38)
CPK 11485 U/L (<294)

Everytime i would gym or go for a run my CPK would shoot up to a similar high number and i would be practically immobilised by muscle pain and i kind of stupidly assumed that everyone experienced this and often tried to push through the pain or wait for couple weeks for the pain to subside before doing the exact same thing again.
I would say that this effect started when i was around 17 maybe earlier (25 currently) about a year ago i started taking testostrone and protein powder and have not experienced that effect since(no idea why). I also realised that the feeling of sore muscles after working them the day before was something completely different haha.

IGF-1 50 nmol/L (18-51)
Serum 25(OH) Vitamin D 22 nmol/L (51-200)
Growth Hormone < 1.0 mIU/L (<3.1)

Cholesterol
LDL-C: 1.27 mmol./L (<2.0)
HDL-C: 1.05 mmol/L (>1.0)
TC: 2.59 mmol/L (<4.0)
TG: 0.61 mmol/L (<2.0)

Osteopenia with Z-score of -1.76
negative for kleinfelters
negative for celiacs disease blood test

my diet is pretty basic, chicken rice broccoli egg sweet potato yohurt banana everyday
I cook with iodised salt and i like to snack on seaweed crackers.
No alcohol, no smoking

When coming off the testostrone i have noticed that after a month my total testosterone can bounce up to 20 nmol/L but within a month after is has always then decreased and stayed at a level usually around 7,8,9 nmol/L.

Since starting testostrone my quality of life has drastically improved in almost every aspect. I however am failing to understand some of my results and would appreciate some input.

You are massively hypothyroid as indicated by your TSH, even if Free T3 comes back good, TSH is still hinting at hypothyroidism. TRT will not work if thyroid problems exist, if anything you may experience worse symptoms as TRT attempts to restore metabolic rates your thyroid simply cannot match.

Never at any time should TSH be as high as it is, high TSH is essentially is the pituitary screaming at the thyroid to produce thyroid hormones. If you doctor isn’t going to test for estrogen while on TRT, then find another doctor. When my estrogen is high, I am fatigued and mind has glue in it as I can hardly think or remember things.

Everything you’re saying sounds like estrogen is very high, estrogen be can the most difficult thing to manage while on TRT, especially if the doctor isn’t testing for it. Basically is you are overweight and you attempt high normal levels, you are more than likely going to be dealing with high normal levels of estrogen.

If you want to lower estrogen and keep testosterone high, you’re going to have to decrease the dosage.

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